I grant permission for my child to participate in the LWSA / AJAX Premier Tryouts, clinics, camps, and rentals. Further, I declare that my child is in good health. I hereby release and indemnify the Leszek Wrona Soccer Academy and any affiliated organizations, sponsors, employees, and owners from any liability claim on behalf of the
registrant.

In consideration of being allowed to participate in any way and/or enter upon, use and/or
engage in sports activities by Leszek Wrona Soccer Academy, LLC, including participation in
practices, events and/or other uses of the indoor facility at 541 North Main Street Bristol CT,
and their athletic/sports programs and related events and activities, the undersigned:

1. Agrees to prior to participating he/she will inspect the facilities and equipment to be used,
and if he/she believes anything is unsafe, he/she will immediately advise a representative of
Leszek Wrona Soccer Academy, LLC, of such conditions and refuse to participate;

2. Acknowledge and fully understand that each participate will be engaging in activities that
involve risk of serious injury, including permanent disability and death, and severe social and
economic losses which might result not only from their own actions, inaction, or negligence of
others, the rules of play, or the condition of the premises or of any equipment used. Further
that there might be other risks not known to us or not reasonably foreseeable at the time;

3. Assume all the foregoing risks and accept personal responsibility for the damage following
such injury, permanent disability or death;

4. Release, waive, discharge and covenant not to sue Leszek Wrona Soccer Academy, LLC, or its
affiliated clubs, it’s respective members, administrators, directors, coaches, and other
employees of said organization, participants, sponsoring agencies, sponsors, advertisers, and if
applicable, owners and lessees of the premises used to conduct the event, all of which are
hereinafter referred to as “releases”, from demand, losses or damages on account of injury,
including death and damage to
property, caused or alleged to be caused in whole or in part by the negligence of the releases or
otherwise;

5. Shall defend, indemnify and hold Leszek Wrona Soccer Academy, LLC, its officers, employees,
and agents harmless from and against any and all liability, loss, expense, including reasonable
attorney fees, or claims for injury or damages arising out of the performance of this Agreement
but only in proportion to and to the extent such liability, loss, expense, attorney fees, or claims
for injury or damages caused by or result from the negligent or intentional acts or omissions of
the individual or group renting space from the facility, its officers, agents or employees.

THE UNDERSIGNED HAVE READ AND ACKNOWLEDGED THAT HE/SHE IS ENTERING THE ABOVE
WAIVER AND RELEASE, UNDERSTANDING THAT THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT AND SIGN IT VOLUNTARILY, WITHOUT LIMITING THE GENERALITY OF THE
FOREGOING, IT IS MY INTENTION ON BEHALF OF MYSELF OR MY MINOR CHILD TO
SPECIFICALLY RELEASE AND INDEMNIFY LESZEK WRONA SOCCER ACADEMY, LLC, FROM ANY
AND ALL CLAIMS ARISING FROM THEIR OWN NEGLIGENCE. I AGREE TO INDEMNIFY , DEFEND,
AND HOLD HARMLESS LESZEK WRONA SOCCER ACADEMY, LLC FROM ANY LIABILITIES, LOSSES,
DAMAGES, SETTLEMENTS, CLAIMS, EXPENSES, AND COSTS ARISING FROM MY OR MY CHILD'S PARTICIPATION IN THE DESCRIBED ACTIVITY, SAID INDEMNITY TO INCLUDE COURT COSTS AND REASONABLE ATTORNEY FEES.

In consideration of being allowed to participate in any way and/or enter upon, use and/or engage in sports activities by Leszek Wrona Soccer Academy and Ajax Premier including participation in practices, events and/or other uses of the indoor facility at 541 North Main Street, Bristol, Connecticut, and their athletic/sports programs and related events and activities, the undersigned:
1. Agrees that prior to participating, he/she will inspect the facilities and equipment to be used, and if he/she believes anything is unsafe, he/she
will immediately advise a representative of Leszek Wrona Soccer Academy and Ajax Premier of such condition(s) and refuse to participate;
2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not
reasonably foreseeable at this time;
3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death;
4. Release, waive, discharge and covenant not to sue Leszek Wrona Soccer Academy and Ajax Premier or their affiliated clubs, their respective
members, administrators, directors, coaches and other employees of said organizations, participants, sponsoring agencies, sponsors,
advertisers, and, if applicable, owners and lessees of premises used to conduct the event, all of which are hereinafter referred to as “releasees”, from demand, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise;
5. Shall defend, indemnify, and hold Leszek Wrona Soccer Academy and Ajax Premier its officers, employees, and agents harmless from and
against any and all liability, loss, expense, including reasonable attorneys’ fees, or claims for injury or damages arising out of the performance of this Agreement but only in proportion to and to the extent such liability, loss, expense, attorneys’ fees, or claims for injury or damages are caused by or result from the negligent or intentional acts or omissions of the individual or group renting space from the facility, its officers, agents or employees.
THE UNDERSIGNED HAVE READ AND ACKNOWLEDGE THAT HE/SHE IS ENTERING INTO THE ABOVE WAIVER AND RELEASE,
UNDERSTANDING THAT THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, IT IS MY INTENTION ON BEHALF OF MYSELF OR MY MINOR CHILD TO SPECIFICALLY RELEASE AND INDEMNIFY LESZEK WRONA SOCCER ACADEMY and AJAX PREMIER FROM ANY AND ALL CLAIMS
ARISING FROM THEIR OWN NEGLIGENCE. I AGREE TO INDEMNIFY, DEFEND AND HOLD LESZEK WRONA SOCCER ACADEMY and AJAX PREMIER FROM ANY LIABILITIES, LOSSES, DAMAGES, SETTLEMENTS, CLAIMS, EXPENSES AND COSTS ARISING FROM MY OR MY CHILD’S PARTICIPATION IN THE DESCRIBED ACTIVITY, SAID INDEMNITY TO INCLUDE COURT COSTS AND REASONABLE ATTORNEY’S FEES.

- Please speak with your physician before starting this exercise program –
COMMUNICABLE DISEASE ASSUMPTION OF RISK, HOLD HARMLESS, RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT In consideration of being allowed to participate in any way and/or enter upon, use and/or engage in sports activities by LESZEK WRONA SOCCER ACADEMY and AJAX PREMIER, including participation in practices, events and/or other uses of the indoor facility at 541 North Main Street Bristol, CT ( collectively referred to herein as the “Facility”), and their athletic/sports programs and related events and
activities ( collectively referred to herein as “Activities”), the undersigned acknowledges and agrees to the following, on my own behalf, on behalf of any minor accompanying me, and on behalf of my personal representative, heirs and next of kin, agents and principals:
1. The novel coronavirus, COVID-19, also known as “severe acute respiratory syndrome coronavirus 2 (“SARS-CoV-2”) has been declared a
worldwide pandemic by governments and public health agencies. SARS-CoV-2, COVID-19 and/or any mutation or variation thereof (hereinafter “COVID-19) is extremely contagious. COVID-19 and other communicable, contagious and/or infectious diseases, and
(collectively, “Disease”) can be spread by exposure to people or otherwise.
2. The unavoidable risk exists that I will become exposed to and/or infected with Disease, and could suffer resulting and/or related death, disability, illness, sickness, infection, disease, syndrome and/or other undesirable health condition, whether now known or unknown from Disease.
3. I am aware that my participation in the Activities and my presence at Facility may cause me to be near and/or in contact with people and/or
things that could raise the risk to me and others of exposure to Disease.
4. I know the risks of exposure cannot be eliminated no matter the degree of care exercised by anyone affiliated with Facility or Activities. No amount of protective measures or devices can guarantee freedom from Disease. By being at Facility, including, without limitation, participating in Activities, I know I could suffer personal injuries, or become ill, temporarily disabled and/or die (collectively “Afflicted”) from Disease. I voluntarily assume these risks and accept sole responsibility that I may be exposed to and/or Afflicted by Disease by entering Facility or
participating in Activities.
5. Knowing the foregoing risks, including the fact that there are unknown risks, I voluntarily choose to enter, and be at Facility and to assume
these risks of my own free will. I will not seek to hold any Release as defined below responsible if I am Afflicted by Disease.
6. If I choose not to assume these risks, I will neither enter Facility nor participate in Activities, and by staying at Facility I affirm my continuing
acceptance of all such risks.
7. I understand that being Afflicted by Disease may result from the actions, omissions, or negligence of myself and others, including, but not
limited to, Releasees as defined below.
8. HEALTH & SAFETY DECLARATION and CONTINUING OBLIGATION. I attest and certify that I do not have and have not tested positive for
or suffered from any symptoms of COVID-19 infection including without limitation cough; shortness of breath or difficulty breathing; fever; chills;
repeated shaking with chills; repeated shaking with chills; generalized muscle pain; headache; sore throat; new loss of sense of taste or smell;
fatigue or other flu-like symptoms (collectively the “Symptoms”), or have been exposed to any person exhibiting such Symptoms or, traveled
outside the United States or to a location known to harbor such disease, in the past thirty (30) days. I am not under any quarantine orders. By my
signature hereto I also agree to immediately inform the Facility if I subsequently suffer such symptoms and to refrain from entering until I provide
satisfactory medical clearance to the Facility and am granted further permission to enter, subject to the terms and conditions of this agreement.
9. PERSONAL PROTECTIVE EQUIPMENT AND DISTANCING. I will provide and use my own personal protective equipment and practice
social distancing (current CDC guidance is at least 6 feet from others whenever possible) and follow all other hygiene and infection control
methods, as prescribed by applicable authorities such as the United States Centers for Disease Control, state and local health officials, or
otherwise in effect at this Facility, to help protect myself and others from Disease.
10. LEAVING IF ILL. If while at Facility I feel or experience any Symptoms I agree that I will immediately leave Facility to seek medical
attention (or seek emergency medical attention at Facility) and that I promptly will notify Facility officials of same.
11. NOT RESTRICTED BY GOVERNMENT ORDERS OR PERSONAL PHYSICIAN. I represent and warrant that any attendance at Facility
and participation in Activities is not restricted by the advice of my personal physician or any governmental or public health order or rule of any
federal, state, county or other applicable authority, including any order or rule due to my age, condition, government or public health orders of
isolation due to illness or quarantine due to my exposure to others who are, were or may have been sick, or for any other reason. If I believe this
is to not be the case, I will either not enter, or will promptly depart, Facility.
12. KNOWING AND VOLUNTARY. I acknowledge that I am voluntarily participating in Activities and visiting the Facility with an express
understanding regarding the coronavirus pandemic and the other dangers described above, and I hereby agree to accept and assume any and
all risks associated therewith. I have made the judgment that the benefits of Facility outweigh the risks that I am assuming.
13. SEVERABILITY AND ENFORCEMENT. This Agreement is intended to be as broad and inclusive as is permitted by the laws of the Province
or State in which Activities are conducted and if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue
in full legal force and effect. I intend for this Agreement to apply any time I am present at any Facility during dates noted above.
14. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, WAIVE, DISCHARGE,
INDEMNIFY, AND HOLD HARMLESS Leszek Wrona Soccer Academy and Ajax Premier , and their respective officers, officials, agents and/or
employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct any program, event, or
activity (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any exposure to Disease that may result in ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR
OTHERWISE, to the fullest extent permitted by law. . I understand and agree that this release includes claims based on the actions, omissions, or negligence of any RELEASE whether Disease exposure occurs before, during, or after entry to Facility and/or participation in Activities at Facility.

By agreeing to be part of our program, you give permission to our organization to use your child’s image and likeness on our website and in other marketing materials for our organization.